Foreign nurses are receiving a crash course in euphemism after bewildered patients expressing the wish to "spend a penny" found themselves being escorted to a hospital shop. Norfolk's Queen Elizabeth hospital has organised special "adapting to life in Norfolk" sessions for Portuguese staff whose otherwise excellent English results in too-literal translations of everyday expressions. Patients, particularly the elderly, face being met with incomprehension when complaining of "feeling under the weather", suffering "pin and needles" or experiencing problems with their "back passage".

Local expressions such as "blar", meaning to cry, and "mawther", meaning "young woman", are also likely to see mystified nurses flicking in vain through conventional phrasebooks. The distinct Norfolk brogue provides another linguistic obstacle for the recruits hired by the Queen Elizabeth Hospital King's Lynn NHS trust. "One of the things people from overseas had difficulty with was our euphemisms such as 'spend a penny'," said a hospital spokesman. "In the past some of the new recruits from abroad, when patients used the expression, were taking people to the hospital shop."

"They all speak exceptional English, but that doesn't necessarily cover the type of English spoken in Norfolk. We have many different phrases and sayings in this part of the world. A lot of patients are elderly and use what can only be described as quaint phrases and descriptions, especially for body parts and common illnesses." The hospital has organised two-hour induction courses in dialect, idiom and colloquialism, covering phrases such as "spick and span", "higgledy-piggledy", "la-di-dah" and "tickled pink". Other useful terms on the agenda are "jim jams", "a cuppa" and "elbow grease". Nurses are being asked to write down any confusing phrases they hear on the wards so they can be discussed in follow-up meetings.

Katherine Murphy, chief executive of the Patients' Association, said the training would ensure "safe service" in hospitals. "Anyone working for the NHS - nurse, doctor, other healthcare professional, healthcare assistant - must be able to be understood by the patient and must demonstrate that they are safe to treat patients," she said. But Fiona McEvoy, of the Taxpayers' Alliance, resorting to idiom herself, said it was "using a sledgehammer to crack a nut". It made more financial sense for foreign nurses to pick up local phrases "from hearing them used and being advised by peers", she said.